ALLOGENEIC BONE-MARROW TRANSPLANTATION FOR CHRONIC MYELOID-LEUKEMIA USING SIBLING AND VOLUNTEER UNRELATED DONORS - A COMPARISON OF COMPLICATIONS IN THE 1ST 2 YEARS
ALLOGENEIC BONE-MARROW TRANSPLANTATION FOR CHRONIC MYELOID-LEUKEMIA USING SIBLING AND VOLUNTEER UNRELATED DONORS - A COMPARISON OF COMPLICATIONS IN THE 1ST 2 YEARS
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DOI：
10.7326/0003-4819-119-3-199308010-00005
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发表时间：
1993-08-01
影响因子：
39.2
通讯作者：
GOLDMAN, JM
中科院分区：
文献类型：
--
作者：
MARKS, DI;CULLIS, JO;GOLDMAN, JM
目的：比较人类白细胞抗原相合同胞供者和无血缘关系志愿者骨髓移植治疗慢性粒细胞白血病患者的近期和中期并发症(尤其是感染)。设计：对两个队列患者进行回顾性研究。地点：第三转诊中心。患者：103例慢性粒细胞白血病第一慢性期患者。干预：患者接受了来自人类白细胞抗原相合同胞(n=57)和志愿者供者(n=46)的骨髓移植。主要结果：总共68例患者从骨髓移植到骨髓移植的中位生存期为22个月(7~81个月)。同胞供者组2年内总生存率和无白血病生存率的精算概率分别为73%(95%CI，60%~86%)和72%(CI，60%~84%)，志愿者供者组分别为47%(CI，31%~63%)和42%(CI，26%~58%)(P=0.07和0.05)。然而，在调整了病程后，两个捐赠者组的总体和无病存活率没有显著差异。一个主要问题是志愿者无血缘关系捐赠者组严重病毒感染的发生率增加(46名患者中有16名患者发生19例，而57名兄弟姐妹捐赠者中有7名患者发生7例，P=0.01)。慢性移植物抗宿主病(GVHD)的精算发病率在志愿者无关供者中较高(77%[CI，63%~91%]比49%[CI，35%~63%]；P=0.02)，但急性GVHD并非如此。自愿捐赠者组幸存者的中位数表现状况与兄弟姐妹捐赠者组相似。到目前为止，两组的血液学复发率都很低。结论：结果似乎证明在慢性期慢性髓系白血病中继续使用志愿者捐赠者是合理的，但感染和慢性移植物抗宿主病仍然是主要问题。
Objective: To compare the short- and medium-term complications (particularly infection) of bone marrow transplantation for chronic myeloid leukemia in patients with HLA-identical sibling donors or volunteer unrelated donors.Design: Retrospective review of two cohorts of patients.Setting: Tertiary referral center.Patients: One hundred three patients with chronic myeloid leukemia in first chronic phase.Intervention: Patients were treated with bone marrow transplantation using marrow from HLA-identical siblings (n = 57) and volunteer donors (n = 46).Main Results: In total, 68 patients survived a median of 22 months from bone marrow transplant (range, 7 to 81 months). The actuarial probabilities of overall survival and leukemia-free survival at 2 years for the sibling donor group were 73% (95% CI, 60% to 86%) and 72% (CI, 60% to 84%), respectively, and for the volunteer donor group, 47% (CI, 31% to 63%) and 42% (CI, 26% to 58%) (P = 0.07 and 0.05, respectively). However, after adjustment for duration of disease, overall and disease-free survival in the two donor groups did not differ significantly. A major problem was an increased incidence of severe viral infection in the volunteer unrelated donor group (19 episodes in 16 of 46 patients compared with 7 episodes in 7 of 57 sibling donor patients, P = 0.01). The actuarial incidence of chronic graft-versus-host disease (GVHD) was higher in volunteer unrelated donor patients (77% [CI, 63% to 91%] compared with 49% [CI, 35% to 63%]; P = 0.02) but that of acute GVHD was not. The median performance status of the survivors in the volunteer donor group is similar to that in the sibling donor group. The incidence of hematologic relapse in both groups so far is low.Conclusion: Results appear to justify the continued use of volunteer donors in chronic-phase chronic myeloid leukemia, but infection and chronic GVHD are still major problems.